Deadly gastric cancer linked to fatty diet on the rise

NUH study finds that only one in five patients lives past five years

By Poon Chian Hui, The Straits Times, 13 Aug 2012

A TYPE of stomach cancer associated with high-fat diets is on the rise in Singapore.

Gastric cardia cancer, as it is called, is also more aggressive than gastric distal cancer, or common gastric cancer.

Only one in five patients with gastric cardia cancer is still alive after five years, a National University Hospital (NUH) team of doctors has found.

Six in 10 of those with common gastric cancer make it past five years.

While common gastric cancer is caused by the Helicobacter pylori bacteria and a diet high in salt, gastric cardia cancer has its roots in molecules activated by fatty Western-style diets.

The results of an NUH study published last year in the World Journal of Surgery noted that gastric cardia cancers made up 20 per cent or 32 of the 160 stomach cancers treated there.

Data from other sources put gastric cardia cancers at under 10 per cent of stomach cancers back in the 1990s.

With this upward trend, Singapore mirrors that in countries such as Britain and the United States, where the number of gastric cardia cancer cases has risen by 5 per cent to 10 per cent yearly.

Associate Professor Jimmy So, director of the upper gastrointestinal surgery service at NUH, said: "We're a bit worried about this sub-type of cancer. Even after treatment, the relapse rate is higher than for common stomach cancer."

Gastric cardia cancer returned in eight in 10 NUH patients in the study; among patients with common stomach cancer, the relapse rate was half.

Prof So said the trend is likely to worsen as local diets become more like those in the West.

Gastric cardia cancers are also linked to smoking and obesity - which are also on the rise in Singapore. About 14.3 per cent of adults smoke, up from 12.6 per cent in 2004. And 10 per cent of people are obese, up from 6.9 per cent in 2006.

Compounding the problem is heartburn, a condition that obese people tend to develop, which raises the risk of gastric cardia cancer. Treatment for this cancer involves chemotherapy and removing the entire stomach.

Prof So noted that most NUH patients are diagnosed when the cancer is already at an advanced stage.

A key reason is the lack of awareness. Another is the fear of undergoing an endoscopy, he said. This entails inserting a tube into the mouth and down the gastric tract to check for stomach ulcers and tumours.

But an endoscopy remains the best way to detect the cancer, especially since not everyone has warning signs such as stomach pain and loss of appetite, he said.

More than 500 stomach cancer cases surface each year. It is among the top five cancers in men and ranks seventh among women.

This month is gastric cancer awareness month.

The NUH and the Singapore Cancer Society are holding a free public forum on Saturday, 18 Aug. Those interested may call 6421-5804 to register.